Question This 62-year-old gentleman was admitted at 09:00 with a presenting c

Question This 62-year-old gentleman was admitted at 09:00 with a presenting complaint of chest pain  History of Presenting Complaint Over the last few weeks this man has been experiencing occasional tightness across his chest. This has generally occurred while he has been exerting himself and especially when working outside in the colder weather. He also reports a similar but less intense discomfort after eating a big meal. The tightness that he has been experiencing has lasted 6 or 7 minutes and generally resolves if he stops what he is doing. The pain that prompted this admission came on suddenly about 2 hours ago while he was getting dressed for work. It began as a tightness that was similar in nature to the episodes he has been experiencing lately. However on this occasion the tightness developed into a more intense pain that he rates as 8 out of 10. The pain / tightness is mainly across the front of his chest. He is aware of it up into his jaws and his arms feel really heavy. He has never experienced anything as bad as this before. Nothing appears to worsen or relieve the pain. The Paramedics gave him 10mgs Morphine IV and he has vomited a number of times since then. He is very pale and sweaty on admission. He is overweight at 130 kg and measures 180 cm in height.  Past Medical History ? Hypertension for many years (takes a beta blocker for this). ? Road traffic accident 10 years ago resulting in a fractured sternum and multiple rib fractures. ? He says that he is allergic to Aspirin as he developed a rash when he had it before.  Social History ? He lives with his wife. ? They have two sons both of whom live out of state. ? He smokes 20 cigarettes a day and drinks about 8 cans of beer each week. ? He works as a freelance brick layer and has been working long hours recently as his employer has a contract to build a large number of homes.  On Admission: He is distressed and is tachypneic and sweating. He is still experiencing severe chest pain although it has dulled in intensity. He has evidence of peripheral cyanosis.  Table 1: Vital signs on admission  Blood Pressure 90 / 50 mmHg Pulse rate 95 (regular) Respiratory rate 20 per minute Tympanic temperature 37.4 OC SaO2 91% on 4 liters of oxygen Random blood glucose 16.1. mmols/L   Table 2: Blood results Test Result Reference range Sodium 136 136 – 144 Potassium 4.4 3.5 – 5.0 Chloride 102 95 – 105 Urea 8.9 3.0 – 8.3 Creatinine 122 80 – 130 Hematology Hemoglobin 164 120 – 160 Mean Cell Volume 87 80 – 98 White Cell Count 11.6 4.0 – 11.0  In pairs, discuss this patient presentation and: ? Comment on likely medical diagnosis ? List possible nursing diagnoses ? Identify priorities in his management (list at least 4 priorities including rationale).   Health Science Science Nursing NURSING NUR2356 Share QuestionEmailCopy link Comments (0)

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